John D. Sprandio, MD
In 2002, when fee-for-service payment structures were already arousing concern because of how they encouraged unneeded care, Pennsylvania oncologist John D. Sprandio, MD, separated his Philadelphia-area group, Consultants in Medical Oncology and Hematology (CMOH), from a large oncology practice chain so that he could create a patient-centered medical home with standardized treatment, greater efficiencies, lower overall costs, happier patients, and more advantageous agreements with payers.
Sprandio’s practice appeared to thrive as he embraced software designed to overhaul phone triage and symptom management. He shrunk his workforce and dramatically lowered emergency department (ED) visits and hospital admissions among his patients, demonstrating better management of disease. Meanwhile, his pioneering work transformed him into a national figure in the oncology business world. “Dr Sprandio has certainly been an innovator and modernized his practice in a way that has been almost unparalleled in oncology,” said Jeffrey C. Ward, MD, of Swedish Cancer Institute in Edmonds, Washington.
Now Sprandio has changed direction. Since striding off as an independent to develop a successful value-based care system, he has joined another large organization, saying it is time to combine his innovations in care and apply them through a network of practices that can offer technology and data access that were beyond the scope of CMOH.
Sprandio joined forces with The US Oncology Network (The Network), a physician practice management company. “The Network model of standardized business practices, its role in aggregating practices in a market, and its ability to serve as a capital partner were very compelling,” he said. The deal afforded him a measure of independence and created advantages that might enable his innovations to be adopted on a much broader scale.
Even before the partnership, Sprandio’s innovations had influenced oncology care beyond the boundaries of the 5 practices in CMOH. For example, the Centers for Medicare & Medicaid Services (CMS) based some of the architecture of the Oncology Care Model (OCM) on CMOH’s efficiency models. CMOH is an OCM participant. In addition, Sprandio’s business ties with The Network were already formed. The Network had licensed proprietary software for patient-centric care that was developed by Sprandio’s consulting company, Oncology Management Services in Conshohocken, Pennsylvania.
Behind the Decision
In an interview, Sprandio expanded on his practice’s decision to join the practice management company that works with about 20% of oncology practices in the United States. One reason for the move, he said, was to help facilitate growth in the southeastern Pennsylvania market. To succeed with payers and their increasingly rigorous prior-authorization policies for approvals of costly oncology drugs, adherence to high standards of care must be demonstrated, Sprandio said: “Payers in our market, as well as expanding primary-care independent practice associations and affordable care organizations, are clearly in search of specialists who are committed to deliver a new and continuously improving value proposition for complex oncology care.”
The partnership also supplies capital for expansion. “Our practice’s superior clinical results, our National Committee for Quality Assurance recognition, and the potential of having The Network as a capital partner will allow us to collaborate with payers, health systems, and hospitals in order to build out and improve existing patient services,” Sprandio said.
In 2015, CMOH reported robust numbers on practice efficiencies that would have sounded appealing to potential partners struggling to align with the value-based direction espoused by CMS and now being imposed through the OCM and the Medicare Access and CHIP Reauthorization Act of 2015.
CMOH reported that its chemotherapy patients were averaging 0.541 ED visits per year, down from 2.6 visits 10 years earlier and well below the national average of 2 per year. Sprandio estimated he was saving payers $1 million per physician per year. He also estimated that, adopted nationwide, his model could cut $8 billion to $16 billion from annual cancer spending. “To be able to reproduce that model across the country is something I find extremely, extremely, extremely exciting,” Sprandio told OncologyLive® at that time. RETAINING A COMMITMENT TO VALUE-BASED CARE
Retaining a Commitment to Value-Based Care
Although Sprandio sought to expand his practice’s horizons through the deal with The Network, he wanted to preserve the achievements in value-based care that are his trademark. “We developed and introduced the concept of the oncology patient–centered medical home in 2009, broadly known as the oncology medical home,” he said.